Prevalence of hippocampal morphologic variants between healthy elderly subjects and patients with Alzheimer's disease

Authors

1 Department of Radiology, Image Processing and Signal Research Centre, Al Zahra Hospital, Isfahan University of Medical Sciences, Iran

2 Radiologist, Tehran, Iran

3 Department of psychiatry, Al Zahra Hospital, Isfahan University of Medical Sciences, Iran

4 Medical student, London University, England

Abstract

Background: Alzheimer's disease (AD) is a neurodegenerative disease with atrophic changes in the temporal lobe. Enlargement of cerebrospinal fluid (CSF) spaces, hippocampal sulcus (HS) enlargement, or an increase in the number or size of hippocampal cavities (HCs) could be associated with medial temporal lobe atrophy (MTA). In this study, we assessed the relation of these CSF spaces with AD.
Materials and Methods: A total 36 demented patients with diagnosis of Alzheimer (Mini-Mental State Examination (MMSE) ≤25) and 36 non-demented elderly individuals were referred for basic magnetic resonance imaging (MRI) before initiating anti-dementia therapy in the demented group. Two observers assessed the maximal HS width, as well as the occurrence, number, and size of HCs, and the visual rating score of MTA on magnified coronal high-resolution T1-weighted MR images.
Results : The findings of our study indicate that the presence of hippocampal cavity (HC) (especially in the left side) and medial temporal lobe atrophy in demented patients was significantly higher in comparison with non-demented elderly subjects ( P ≤ 0.05). There was a significant relationship between MTA and HS width ( P = 0.003, r = 0.00323), and it also had a trend to be significant with size of HCs ( P = 0.08, r = 0.00314). A correlation between MTA and number of HCs was not detected.
Conclusion : HS width is associated with MTA in patients with AD. It may serve as a measure to evaluate MTA for identifying individuals at particularly high risk for Alzheimer progression, and could be employed for selecting subjects for clinical trials or for treatment decisions.

Keywords

1. Braak H, Braak E. Frequency of stages of Alzheimer-related lesions in different age categories. Neurobiol Aging 1997;18:351-7.  Back to cited text no. 1
[PUBMED]    
2. Fratiglioni L, Viitanen M, Von Strauss E, Tontodonati V, Herlitz A, Winblad B. Very old women at highest risk of dementia and Alzheimer's disease: Incidence data from the Kungsholmen Project, Stockholm. Neurology 1997;48:132-8.  Back to cited text no. 2
[PUBMED]    
3. Schupf N, Kapell D, Nightingale B, Rodriguez A, Tycko B, Mayeux R. Earlier onset of Alzheimer's disease in men with Down syndrome. Neurology 1998;50:991-5.  Back to cited text no. 3
[PUBMED]    
4. Price JL, Morris JC. Tangles and plaques in nondemented aging and "preclinical" Alzheimer's disease. Ann Neurol 1999;45:358-68.  Back to cited text no. 4
    
5. Bastos-Leite AJ, van Waesberghe JH, Oen AL, van der Flier WM, Scheltens P, Barkhof F. Hippocampal sulcus width and cavities: Comparison between patients with Alzheimer disease and nondemented elderly subjects. AJNR Am J Neuroradiol 2006;27:2141-5.  Back to cited text no. 5
    
6. Braak H, Braak E. Neuropathological stageing of Alzheimer-related changes. Acta Neuropathol 1991;82:239-59.  Back to cited text no. 6
[PUBMED]    
7. Ball MJ, Fisman M, Hachinski V, Blume W, Fox A, Kral VA, et al. A new definition of Alzheimer's disease: A hippocampal dementia. Lancet 1985;1:14-6.  Back to cited text no. 7
    
8. Gómez-Isla T, Hollister R, West H, Mui S, Growdon JH, Petersen RC, et al. Neuronal loss correlates with but exceeds neurofibrillary tangles in Alzheimer's disease. Ann Neurol 1997;41:17-24.  Back to cited text no. 8
    
9. Terry RD, Masliah E, Salmon DP, Butters N, De Teresa R, Hill R, et al. Physical basis of cognitive alterations in Alzheimer's disease: Synapse loss is the major correlate of cognitive impairment. Ann Neurol 1991;30:572-80.  Back to cited text no. 9
    
10. Thompson PM, Hayashi KM, de Zubicaray G, Janke AL, Rose SE, Semple J, et al. Dynamics of gray matter loss in Alzheimer's disease. J Neurosci 2003;23:994-1005.  Back to cited text no. 10
[PUBMED]    
11. Bobinski M, de Leon MJ, Convit A, De Santi S, Wegiel J, Tarshish CY, et al. MRI of entorhinal cortex in mild Alzheimer's disease. Lancet 1999;353:38-40.  Back to cited text no. 11
[PUBMED]    
12. Bobinski M, de Leon MJ, Wegiel J, Desanti S, Convit A, Saint Louis LA, et al. The histological validation of post mortem magnetic resonance imaging-determined hippocampal volume in Alzheimer's disease. Neuroscience 2000;95:721-5.  Back to cited text no. 12
[PUBMED]    
13. Convit A, de Leon MJ, Tarshish C, De Santi S, Kluger A, Rusinek H, et al. Hippocampal volume losses in minimally impaired elderly. Lancet 1995;345:266.  Back to cited text no. 13
    
14. Detoledo-Morrell L, Sullivan MP, Morrell F, Wilson RS, Bennett DA, Spencer S. Alzheimer's disease: In vivo detection of differential vulnerability of brain regions. Neurobiol Aging 1997;18:463-8.  Back to cited text no. 14
    
15. Killiany RJ, Moss MB, Albert MS, Sandor T, Tieman J, Jolesz F. Temporal lobe regions on magnetic resonance imaging identify patients with early Alzheimer's disease. Arch Neurol 1993;50:949-54.  Back to cited text no. 15
    
16. Barboriak DP, Doraiswamy PM, Krishnan KR, Vidyarthi S, Sylvester J, Charles HC. Hippocampal sulcal cavities on MRI: Relationship to age and apolipoprotein E genotype. Neurology 2000;54:2150-3.  Back to cited text no. 16
    
17. de Leon MJ, Golomb J, George AE, Convit A, Tarshish CY, McRae T, et al. The radiologic prediction of Alzheimer disease: The atrophic hippocampal formation. AJNR Am J Neuroradiol 1993;14:897-906.  Back to cited text no. 17
    
18. Sasaki M, Sone M, Ehara S, Tamakawa Y. Hippocampal sulcus remnant: Potential cause of change in signal intensity in the hippocampus. Radiology 1993;188:743-6.  Back to cited text no. 18
[PUBMED]    
19. Yoneoka Y, Kwee IL, Fujii Y, Nakada T. Criteria for normalcy of cavities observed within the adult hippocampus: High-resolution magnetic resonance imaging study on a 3.0-T system. J Neuroimaging 2002;12:231-5.  Back to cited text no. 19
[PUBMED]    
20. O'Brien JT, Desmond P, Ames D, Schweitzer I, Chiu E, Tress B. Temporal lobe magnetic resonance imaging can differentiate Alzheimer's disease from normal ageing, depression, vascular dementia and other causes of cognitive impairment. Psychol Med 1997;27:1267-75.  Back to cited text no. 20
[PUBMED]    
21. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-44.  Back to cited text no. 21
    
22. de Leon MJ, George AE, Stylopoulos LA, Smith G, Miller DC. Early marker for Alzheimer's disease: The atrophic hippocampus. Lancet 1989;2:672-3.  Back to cited text no. 22
    
23. Petersen RC, Jack CR, Xu YC, Waring SC, O'Brien PC, Smith GE, et al. Memory and MRI-based hippocampal volumes in aging and AD. Neurology 2000;54:581-7.  Back to cited text no. 23
    
24. Bastos-Leite AJ, Scheltens P, Barkhof F. Pathological aging of the brain: An overview. Top Magn Reson Imaging 2004;15:369-89.  Back to cited text no. 24
    
25. George AE, de Leon MJ, Stylopoulos LA, Miller J, Kluger A, Smith G, et al. CT diagnostic features of Alzheimer disease: Importance of the choroidal/hippocampal fissure complex. AJNR Am J Neuroradiol 1990;11:101-7.  Back to cited text no. 25
    
26. Frisoni GB, Beltramello A, Weiss C, Geroldi C, Bianchetti A, Trabucchi M. Linear measures of atrophy in mild Alzheimer disease. AJNR Am J Neuroradiol 1996;17:913-23.  Back to cited text no. 26
    
27. Frisoni GB, Geroldi C, Beltramello A, Bianchetti A, Binetti G, Bordiga G, et al. Radial width of the temporal horn: A sensitive measure in Alzheimer disease. AJNR Am J Neuroradiol 2002;23:35-47.  Back to cited text no. 27
[PUBMED]    
28. Bastos AC, Andermann F, Melançon D, Cendes F, Guberman A, Dubeau F, et al. Late-onset temporal lobe epilepsy and dilatation of the hippocampal sulcus by an enlarged Virchow-Robin space. Neurology 1998;50:784-7.  Back to cited text no. 28
    
29. Awad IA, Johnson PC, Spetzler RF, Hodak JA. Incidental subcortical lesions identified on magnetic resonance imaging in the elderly: Postmortem pathological correlations. Stroke 1986;17:1090-7.  Back to cited text no. 29
[PUBMED]    
30. Barkhof F. Enlarged Virchow-Robin spaces: Do they matter? J Neurol Neurosurg Psychiatry 2004;75:1516-7.  Back to cited text no. 30
[PUBMED]    
31. Maclullich AM, Wardlaw JM, Ferguson KJ, Starr JM, Seckl JR, Deary IJ. Enlarged perivascular spaces are associated with cognitive function in healthy elderly men. J Neurol Neurosurg Psychiatry 2004;75:1519-23.  Back to cited text no. 31
[PUBMED]    
32. Laakso MP, Soininen H, Partanen K, Lehtovirta M, Hallikainen M, Hänninen T, et al. MRI of the hippocampus in Alzheimer's disease: Sensitivity, specificity, and analysis of the incorrectly classified subjects. Neurobiol Aging 1998;19:23-31.  Back to cited text no. 32